M.D. Update February 2011 - Cardiology

Kentucky Edition

FEbruary 2011

Issue spotlIght:

Cardiology

New Paradigm in Vascular Care ThE busiNEss magaziNE oF KENTucKy PhysiciaNs

aNd hEalTh carE admiNisTraTors

At the Heart of the Matter Cleveland Clinic Comes to Pikeville MC

Employment Opportunities VolumE 2, NumbEr 2

Louisville Cardiology Group takes a stand on physician employment, joins Baptist Medical Associates and maintains autonomy in the deal.

Saint Joseph Heart Institute Welcomes Dr. Michelle Morton Saint Joseph Heart Institute is pleased to announce that cardiologist Michelle Morton, M.D. is available to see patients in her new office at The Women’s Hospital at Saint Joseph East.

Dr. Morton specializes in the treatment of heart disease in women, focusing on Preventive Cardiac Care, Coronary Heart Disease, Congestive Heart Failure, Hyperlipidemia, and Hypertension.

Medical Highlights: • Completed Medical School, Internal Medicine, Residency & Cardiac Fellowship Training at University of Kentucky Medical Center • Diplomat: American Board of Cardiovascular Disease • 2002 • Diplomat: American Board of Internal Medicine • 1999 Services Include: • Diagnostic Cardiac Catheterization • Nuclear Cardiac Imaging • Echocardiography • Cardiac Stress Testing • Heart Failure Medication Management Saint Joseph Cardiology Associates The Women’s Hospital at Saint Joseph East 170 N. Eagle Creek Drive Lexington, KY 40509 P 859.629.7100 F 859.313.3224

www.SaintJosephHeartInstitute.org

February 2011 1

Letters

FrOM tHe DesK OF

Megan Campbell Smith, editor-in-chief

Kentucky Issue Volume 2, Number 2 February 2011 Publisher

Gil Dunn gdunn@md-update.com editor in Chief

Dear Reader, After several years of producing two regional market editions, M.D. Update breaks new ground this month with our first statewide edition. We welcome to our readership the physicians of Owensboro and practice managers from across the state.

In response to the changing demands on the healthcare industry, we determined that now is the time for us to expand our coverage while enhancing the value of our product.

As you browse this month’s issue, you will doubtless discover a new composition with more photography and subsections containing your favorite columns.

If you grabbed this cover and wondered where all the featured physicians went – don’t worry. We expanded our index on the last page to include the month’s featured physicians. Of course, our advertisers are indexed on the last page too, Megan Cambell smith along with a telephone number.

If you enjoy receiving M.D. Update each month, dear Reader, I hope you will call up one of our advertisers and thank them for their support. We love boasting that we are 100% local and 100% advertorial-free. Being advertisingsupported allows us to fulfill our editorial mission of providing compelling, meaningful coverage of our local healthcare markets in a positive and thoughtful medium.

We hope you feel similarly about M.D. Update. And if you do not, we want to hear your concerns. We Will rotate this space in subsequent issues to feature letters from our readers.

Please let us know what we can do to make M.D. Update more meaningful for you as we work through the industry challenges that lie ahead.

In closing, I’d like to call your attention to the small quote at the left of this page. Our photographer Kirk Schlea took this for me when we were working with our cover subjects in the cath lab at Louisville Cardiology Group. Keep striving for excellence, and we’ll see you here again next month.

Very truly yours, Megan Campbell Smith, editor-in-chief

2 M.D. upDate

Megan Campbell Smith mcsmith@md-update.com AssoCiAte editor:

Greg Backus gbackus@md-update.com PhotogrAPher

Kirk Schlea kirk@ md-update.com Writers:

Dan Dickson ddickson@md-update.com grAPhiC designer:

James Shambhu art@md-update.com

Contributors:

Scott Neal Kathryn Sandusky Dr. Thomas H. Schwarcz

send your letters to the editor to: mcsmith@md-update.com

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921 Beasley Street, Suite 210 Lexington, KY 40509 (859) 309-9939 phone and fax Mentelle Media, LLC is locally owned and operated. Mentelle Media strives to produce top quality referral and marketing resources for Kentucky’s professionals by welcoming the participation of our readers. For more information about how your business or medical practice can get involved, contact Gil Dunn at (859) 309-0720. bulk third class mail paid in bloomington, IN. postmaster: please send notices on Form 3579 to 921 beasley Street, Suite 210 Lexington, Ky 40509 M.D. update is peer reviewed for accuracy.

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COntents COver stOry

2 froM the desK of 5 heAdlines 11 finAnCe 12 CoVer story 15 PersPeCtiVes 20 feAture story 25 sPeCiAlties 30 sPeCiAlty foCus 33 neWs 39 Arts

HeaDLines

6 the rapid rise of pikeville Medical Center’s Heart Institute

Feature stOry

employment Opportunities Louisville Cardiology Group takes a stand on physician employment, joins Baptist Medical Associates and maintains autonomy in the deal. PAGe 12

ON tHe COVer:

Dr. rudy Licandro with Louisville Cardiology Group replaces ICD in the baptist east Cath Lab.

20 at the Heart of the Matter with Lexington Cardiology Consultants

speCiaLty FOCus

30 New paradigm in Vascular Care

February 2011 3

HeaDLines ma s pla maY’ plaY: #1 in heart

Walter e. May announcing the affiliation of pMC with the Cleveland Clinic Heart Surgery program on January 17. pHOtOGrapHy by Casey price/Kyle Lovern (2011)

PiKeVille residents of appalachia have direct access to one of the world’s premier cardiac programs now that pikeville Medical Center (pMC) is affiliated with the Cleveland Clinic Heart surgery program.

During the January 17 announcement, pMC president and CeO Walter e. May made his intentions clear: “pikeville Medical Center did its first surgery only 12 years ago, making us relatively new to the service. as always, we have strived to improve our quality and our outcomes. We believe that working with the Cleveland Clinic Heart and vascular institute will save more lives and help us become the number one heart hospital in this region.” to give a scale to the impact this affiliation has on area residents, the Cleveland Clinic (CC) performs in one year about the same number of heart cases performed at pMC throughout the history of its cardiac program. the affiliation provides pMC staff the opportunity to train in advanced cardiac protocol at the CC, and pMC cardiothoracic surgeons, now credentialed at CC, will be able to assist with cases in Cleveland. in an arrangement that pMC surgeon Dr. Dennis Havens calls a “cooperative learning experience”, pMC and CC will share outcome data and research.

May said, “We will mirror their best practices and protocols here at pMC. Due to this affiliation and the high-quality program we have in pikeville, we plan on doubling the number of heart surgeries we do here in the first year of the affiliation.” ◆

February 2011 5

HeaDLines

the rapid rise of pikeville Medical Center’s Heart institute

If you want to know where an organization is headed, you are wise to learn where it’s been. piKeviLLe About four years ago when Bill Harris, MD, first met with President and CEO Walter E. May to discuss plans for the development of Pikeville Medical Center’s Heart Institute, May described to him a vision for a “high quality, Mayo Clinic-like referral center for this region of the country,” as Harris would later recall.

Now that vision is rendered more complete with the recent affiliation with the Cleveland Clinic’s Heart Surgery Program, which will provide tertiary referral opportunities for about 350,000 Kentucky, Virginia, and West Virginia residents.

Before Pikeville Medical Center (PMC) launched its Heart Institute, area residents “were really disadvantaged for advanced heart health care,” says Harris. “To get advanced care in cardiology, residents would have to make a three to four hour trip, even when an hour could make the difference between life and death.” The need to travel to urban hospitals for cardiology care not only creates financial distress, it increases discomfort for patients who must navigate an unfamiliar environment.

As May would have it, the solution to this problem is a tertiary care center located right in the middle of the rural Appalachian population. “Geographically, Pikeville is the ideal location,” says Harris. “There are not many places that can develop this kind of medical center. It takes smart people, savvy business people and a commitment to the community.”

It also takes talent. In 2006, Harris and Dr. Muhammad Ahmad, both interventional cardiologists, helped found the Heart Institute, which became a full-service cardiology program when electrophysiologist Dr. Michael Antimisiaris joined in late 2009. “We are doing all types of procedures necessary to be considered a secondary, if not a tertiary, referral center for cardiology,” says Antimisiaris. The electrophysiology (EP) program offers all types of available 6 M.D. upDate

bill Harris, MD

“Geographically, Pikeville is the ideal location,” says Harris. “There are not many places that can develop this kind of medical center. It takes smart people, savvy business people and a commitment to the community.”

ablations and devices for the treatment of arrhythmias.

“In the four years I have been here, we have grown from a two-person cardiology practice to a seven-person practice, and we’re still growing,” explains Harris. “We have three heart surgeons [now affiliated with the Cleveland Clinic], interventional cardiology, state-of-the-art imaging for cardiology, EP and advanced technology as good as anywhere else. We have all the same toys as the Cleveland and Mayo Clinics.” By the middle of 2010, PMC had become a Level 3 Certified Chest Pain Center with percutaneous coronary intervention.

Harris points out that in the national cardiology databases, National Cardiovascular Data Registry (NCDR) /ACTION Registry and the Medicare Core Measures, PMC has shown remarkable improvement each year.

“Out of 400 plus hospitals in the country,” says Harris, “We are now 110 or 111. This leaves room for improvement, but does show immense progress.” In Core Measures, he reports, PMC is up in the 90th percentile in treatment of STEMIs.

radial Cath

PMC is one of very few centers in the U.S. offering radial heart caths utilizing the radial artery. While common in Europe, a survey showed only 10 to 15% of cath labs in the States use this approach. “We started ours about six months ago and now we do about 40% of our cases from the radial artery. Patients don’t have to lie on their back, they can sit in a chair and go home in two or three hours,” explains Harris.

This is a convenience and comfort for patients, and Harris explains that data shows there is less bleeding or other significant complications from the radial artery. “Technically, it’s harder for the doctor,” he says, “but we are committed to it. We even have a suite of radial chairs in our recovery area.”

remote Cardiac telemetry

“The Heart Institute is in the process of structuring an integrated, remote follow-

Michael antimisiaris, MD

up system for defibrillator and pacemaker patients,” says Antimisiaris. “We aim to do all our testing over the phone or the internet, thereby reducing the amount of office visits required by the patient.”

Right now, there are about 450 patients whose devices report back to Antimisiaris at the Heart Institute. “The challenge is that it is a time consuming thing because we are identifying more problems than we otherwise would not have been aware of,” he says.

“But, because we are identifying these problems a lot earlier, we can intervene before the patient gets too sick. One example is patients who have heart failure. They have an impedance monitor that can actually tell us if a patient starts to develop fluid in their lungs, a huge issue with heart failure. The monitor can detect this well before the person would begin feeling the effects, like shortness of breath. If we can see that and tell the patient to take an extra water pill for the

next few days it can stop it from getting bad enough and prevent the patient from needing to come in to the hospital,” explains Antimisiaris.

Sustainable enterprise

Harris acknowledges “you can buy all the equipment and have an excellent facility and still do a bad job. Our number one motivation has always been quality, and our second is slow, controlled, rational growth.”

“The reason I came here,” he says, “was to build something with this vision in mind, when you leave, you leave a place better than when you got there. We intend to do everything that we do with excellence.”

Pikeville. Walter May. The people who work here. That’s what Harris says makes Pikeville Medical Center’s Heart Institute unique. “The community is small, and we all know the better care we give, the better care our families and friends receive. There’s really a unity of purpose in making this hospital the best it can be.” ◆ February 2011 7

HeaDLines

Defining aCO from the private Corporate perspective Care navigators, who are widely implemented in complex care, will likely play a greater role in the ACO and in primary care.

“You get better compliance with treatment for patients who are helped by a navigator,” says Hester. Not only does better compliance help to reduce cost, “it is an important part of stewardship on our part. It is value-added to the patient and the physician.”

LOuisviLLe In the summer of 2009, when Norton and Humana partnered in the Brookings Dartmouth pilot project aimed at defining the commercial accountable care organization, health reform was not yet law. The definition of ACO was academic, speculative.

The newly formed Norton/Humana ACO, sets out to define the new venture from the private corporate perspective.

According to Dr. Steven Hester, senior vice president and chief medical officer at Norton, when the Medicare demonstration projects do roll out, these pilot programs will provide details of what an accountable care organization should comprise and how it should be legislated.

Norton and Humana are focused on a singular goal, says Hester, “How do you coordinate care more effectively?” This is not an exercise in finance. Rather it is an investigation into the function and structure of the two independent corporations and determining where sharing resources will result in maximally effective healthcare administration.

For the physician, this program should develop significant insights into problems such as primary care attribution, defining the appropriate care for the population, care management within the healthcare system, and data-sharing among providers and payers.

ACOs offer physicians the potential to step away from administrative burdens.

Moreover, the collaborations may also help them be better physicians through better coordinated care. This would come, in part, from access to information that was not previously available to physicians.

Claims-based data is one example. “If you were able to write a prescription for a patient and have it entered into a database, it would allow the physician to see if the prescription had been filled when the patient comes in for the next visit,” says Hester.

“There is value in that in terms of compliance. In terms of preventative screenings, there are ways to help coordinate care by putting together a prevention database 8 M.D. upDate

accountability triangle Steven Hester, MD, Mba

based on whether the patient has received a flu shot, for example, a colonoscopy, or a mammogram.”

Patients may receive these services from different providers, but the records of these events are kept by their insurance company.

“So if you could use that information to put a database together, it would be of value to the physicians as well.” Hester says the ACO will look to the actuarial data for trends of patient spending and predicting future spending, which will provide additional opportunities to improve care coordination and bring down costs.

It is a widely held belief that primary

According to Hester, better coordinated care is the outcome of the three stakeholders in healthcare working together. This is the accountability triangle, comprised of patient, provider, and payer.

“The patient is at the top of that,” says Hester, “and it is all about getting the patients engaged in understanding the importance of their health. Health literacy is one of those things that you will see talked about a lot, and that is because it is a big part of improving the overall health care delivery system.

“The second point of that triangle is the health care providers, hospitals and physicians. There’s accountability in terms of how we help manage health literacy, and I think that the payers or employers play a role there. There are lots of large employers that are doing significant numbers of wellness programs, because there really is an opportunity to improve the health of your population of employees with those types of programs.

It improves long-term savings to limit obesity, which can help prevent type II diabetes and vascular diseases.

“We are taking this opportunity to discover different ways to coordinate care more effectively, which improves patients’ overall health. As we look at population health, one of the key things new businesses look at when they consider coming to a community is the health status of the population. As we look at this we are trying to help improve the population’s overall health status.” ◆

The Norton / Humana ACO seeks to discover new ways to coordinate care more effectively, which improves patients’ overall health while it reduces healthcare expense. care is an important part of improving health care delivery, engaging patients with primary care is a big part of the project.

So is care management. “We often just expect that people will understand how to use the health care system,” says Hester.

“From an education perspective, I think there is a tremendous opportunity to teach people how to get the right service at the right time.”

HeaDLines

“sudafed Bill” update FranKFOrt As the “Sudafed” Bill nears vote in the Kentucky State Senate ( Senate Bill 45), the House Bill sponsor Representative Linda Belcher says “We are eagerly awaiting the Senate vote to know what our next steps will be.” Belcher’s House Bill 281 would make pseudoephedrine, a component of home-made methamphetamine, a Class IV controlled substance. On the House side, HB 281 is still in committee.

Belcher says that the reason she proposed this bill was were the health and safety concerns over the use and manufacture of meth.

“This bill is designed to protect Kentuckians,” Belcher explains. “Drug use in Kentucky is a major problem. The one thing that law enforcement agencies agree on is that with this bill they can get rid of the meth labs.”

The AMA and KMA, among others, support the legislation. The KMA House of

Delegates, the Association’s governing body consisting of nearly 200 physicians statewide, adopted in resolution in 2010 in support of requiring a prescription for pseudoephedrine -containing medications. According to Marty White, director of Public and Governmental Relations for the KMA, several physicians testified in favor of the resolution because of public health hazard caused by the production of methamphetamine.

“There are multiple over-the-counter alternatives to pseudoephedrine-containing medications for cold and allergy symptom relief that include phenylephrine, which is marketed as Sudafed PE. Phenylephrine is also extremely beneficial in treating the symptoms of colds and allergies when combined with antihistamines and mucolytics, such as Alahist DM. There are literally hundreds of these over-the-counter combination medicines that will effectively treat cold and allergy symptoms,” says White.

“It’s important to note that all of these

medicines, including pseudoephedrine-containing medications, only treat the symptoms and not the cause of the ailments. If a patients’ symptoms are such that they need to visit their physician for a prescription that contains pseudoephedrine,” says White, “the physician is likely to prescribe a medication that will treat the ailment rather than just the symptoms.” White notes that physicians will continue treating patients, their symptoms, and ailments as they always have.

“Obviously, as is the case with prescription drugs, physicians will be mindful of patients who present as if they are seeking drugs for illicit purposes,” he says.

Pseudoephedrine required a prescription until 1976, when it was un-scheduled - over the objection of law enforcement agencies. Today, sales in amounts over 9 grams are blocked. The tracking system National Precursor Log Exchange (NPLEx) monitor sales of pseudoephedrine. NPLEx is privately-held and would not be needed if the Sudafed Bill passes, at which time tracking would fall into the KASPER system. ◆

February 2011 9

FinanCe

One of Life’s Most persistent Questions One of our dear readers requested that I try to be less theoretical and more practical in this space--a request that I am more than willing to try to accommodate. He called for less macro economics (QE2, GDP projections, etc.) and more personal financial advice (retirement planning, tax issues, estate planning, etc.). Specifically, he wanted to know how much his nest egg would have to be if he wanted to target retirement in 18 years with an income of $90,000 in today’s dollars.

On its face that seems like a straightforward question which should have a simple, singular answer. Therein is the problem. Any quick answer fails to consider all the variables; the omission of any can lead to ruin.

Isn’t the more relevant question whether you are currently living within your means, moving toward a desirable living standard during retirement, or whether you are destined to live out senior years on a diet of cat food soufflé? Obviously, sooner or later, we will all need to replace the earning capacity of our own human capital with the earnings of our financial assets. Furthermore, the earnings of those assets will need to beat

will even give you the chance of it happening based on the riskiness of your chosen portfolio. Many financial advisors use a rule of thumb of 4% withdrawal. In short, they are scott neal saying that if you have $1 million dollars in your portfolio then you should be able to withdraw $40,000 after taxes in the first year and have it go up with inflation each year for the rest of your life and be okay. Dr. Laurence Kotlikoff of Boston University refers to such rules as “rules of dumb.” He advises that the free calculators are worth what you pay for them. Most were designed to simply encourage savings and investing, often at the expense of living standard. It is possible to over-save and deprive you and your family of needed resources now.

We fiduciaries know that there is a

Most free retirement calculators are designed to encourage savings and investing. It is possible to over-save and deprive you and your family of needed resources now. taxes and inflation if we have any hope of maintaining a desirable living standard.

The key to a successful retirement is to know the effect of today’s financial decisions, either positive or negative, on the living standard that we will experience throughout the remainder of our lives. Some seemingly innocuous choices today can have far-reaching consequences. Unfortunately, determining the effect of today’s decision on tomorrow’s living standard requires more than a simple calculation.

There are any number of free calculators on the web that will help you to determine the amount of capital needed at age x that will provide income to age y.

Furthermore the calculators will also determine the amount of annual savings needed at return z% in order to amass the needed capital by the time you reach age x. Some

better way to go about this. It is called personal financial planning. It is personal because it is unique to you. We believe that the process begins by establishing a purpose statement for you wealth. What are the possible uses of your wealth? What is the purpose that is at your heart’s core? Do you feel obligated to do certain things with your wealth? What would be fun to do with it if you have more than you truly need? Your answers to these questions guide you toward a purpose statement that ultimately leads to the identification of your goals. Unlike purpose statements, goals are the specific, measureable, achievable, realistic, and timebound objectives for the use of your wealth.

A good goal statement would be to retire in x years with enough money to provide a living standard defined by my ability to spend $ Y a year, adjusted for inflation.

The second step in the process is to determine an exact quantification of your current resources and your expected future resources (which may or may not include social security). To do this, we construct a current balance sheet or statement of financial condition that reflects the current value of all your assets.

The real question of long range planning is how much can I afford to spend to support my living standard? Imagine that all the income that comes to you each year has to go into one of five places: 1) taxes, 2) debt payments, 3) gifts to others, 4) savings and 5) spending. One of the reasons that the free online calculators are so inadequate to the task is that they typically ignore future resources and/or future special expenditures for such things as weddings, new cars, or home improvements. They almost always assume a flat tax rate and never consider that you have a choice of prepaying debt or that you have the desire to give away some money. Instead, they focus solely on smoothing savings each year between now and retirement. That is rarely, if ever, realistic.

Fiduciaries believe that a more realistic view of retirement planning is to use dynamic programming to calculate the maximum sustainable living standard, defined as the amount of money that one can spend this year. In other words, assuming all current and future resources, and taking into consideration taxes, inflation, and any one time expenditure needs, how much will be available to spend this year and every year that will insure that you have a long lived life with a smooth standard of living.

To arrive at the answer requires dynamic programming and quite sophisticated computer modeling of the variables. It cannot be done in this article any better than it can be done by the free online financial calculators. Hopefully, the questions that we have raised here will guide you in the process.

Scott Neal is president of D. Scott Neal, Inc, a fee-only financial planning and investment advisory firm. Send questions and comments to scott@dsneal.com or by calling 1-800-3449098. ◆ February 2011 11

COver stOry

employment mployment Opportunities Chris roty, vice president at baptist Hospital east, with baptist Louisville Cardiology Groups physicians Dr. William Dillon, Dr. rebecca rebecca McFarland, and Dr. rudolph rudolph Licandro.

louisville Cardiology group takes a stand on physician employment, joins baptist Medical Associates and maintains autonomy in the deal.

12 M.D. upDate

LOuisviLLe In December 2010, Baptist Medical Associates announced that the full-service, nine-physician Louisville Cardiology Group had joined the employed physicians group of Baptist Hospital East.

While there was nothing out of the ordinary about the announcement itself – practice employments have occurred weekly since healthcare reform became law in March 2010 – the story behind the announcement is something that physicians should pay attention to.

Chris Roty, vice president at Baptist Hospital East, says that while the timing of the decision is related to healthcare reform, the two organizations have been discussing a partnership for years. They had explored projects like special equipment or starting a new cath lab together, and they kept kicking around ideas because, Roty recalls, their philosophies of care are so similar.

“Louisville Cardiology Group has been on the staff here at Baptist East for over 20 years. We have always had a close affiliation. Dr. Michael Imburgia and I talked two or three years ago about what ideal things we could do, and his idea was the joining of our groups,” says Roty. “Our groups and our philosophies make us a great team. When we looked into it further and talked through it, the light bulb went on.

We could join forces in a formal partnership and grow together.”

Dr. Imburgia, who with Dr. Rudolph Licandro founded Louisville Cardiology Group (LCG) in 1997, says that doctors and hospitals are merging because of what is going to happen down the road with global reimbursement. “But before this merger mania set in, we knew that we were a good match.”

Together Baptist and LCG took a proactive stance – that they could expand and grow together. “What we offered each other was a similarity in practices of how we treat patients,” says Imburgia. “We offer this unique outpatient setting and they have a unique inpatient setting. Now being joined, we expect everything to grow dramatically.”

The philosophy they share is that they must provide the services that patients need, even if they aren’t the popular ones or reimbursed at high rates. Licandro recalls how Baptist approached them with the desire to refine the hospital’s cardiology product and wanted to enlist their help in defining the direction that should go. “They wanted to make investments in things that would be appropriate and helpful, and build something that would be a lasting value to the community and the patients,” says Licandro.

“That intrigued us because when Imburgia and I started out we were very proud of the fact that a lot of the change you see here was driven by us. As a simple example, the way to treat heart attacks in the early 90’s was clot-busting drugs. When we came around, we said that the way to treat people is by taking them to the cath lab. We implemented our ideas, and soon the ER was calling us. We were not doing things better to try to defeat our competition. We were trying to raise the bar because everybody benefits from that.”

One of the unique ways that LCG expresses this philosophy is that they allow their physicians to pursue their passions without being punished for it.

According to Imburgia, “Some procedures can take hours and others can take minutes. Our physicians can practice as they see fit with the ultimate goal of providing the best care possible.

the grand ambition of healthcare reform is that healthcare, as a system, can be made better.

“From the financial standpoint, the way that reimbursement has changed, an insurance company does not care whether a procedure took one hour or four hours to do, it is the same pay. For me to sit in the office and see 20 patients and read 20 tests may take eight hours and generate more revenue than someone spending 10 hours in a cath lab. So with us, physicians are not penalized either way,” Imburgia concludes.

The grand ambition of healthcare reform is that healthcare, as a system, can be made better. In the past, lots of physicians merged with hospitals because they were having a hard time making ends meet financially or they needed to acquire management expertise. “This was not the reason we decided to merge,” says Imburgia. “We were both doing fine on our own in regards to management. For us, the merger was a way for us to make our cardiovascular services better, to make something great.

As a physician, you do not have to merge with a hospital just because you need help, and you do not have to lose autonomy. The best reason to merge is to make something better. This is the message I think that the government has been trying to send.”

Physicians who are wondering how partnership necessitated by healthcare

February 2011 13

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reform will affect their ability to administer care in their own practices can draw a lesson from the Baptist-LCG example. Like a Venn diagram, there is one bubble called administration and another bubble called care. There, in the overlap, are all of the problems of today that will become the reform protocols of tomorrow.

“There is a large population of people being admitted to the hospital whose experience could be more streamlined, better cared for,” says Imburgia, “and we want to prevent them from having to come back.”

Roty agrees, and points out that one of the big hurdles for doctors now is Medicare’s new 30-day readmission rule, that if a patient comes back in after 30 days with the same diagnosis that Medicare is not going to pay for it. “We have to work together to find ways to take better care of the patients and keep them from coming back too much. We are going to have to come up with new strategies.”

To protect physician autonomy and direct the vision of the new venture, LCG and Baptist set up Louisville Cardiology Group (front row, l-r) thomas M. tu, MD; rebecca M. McFarland, MD; rudolph a Cardiology Council that meets F. Licandro, MD, FaCC; with baptist Medical associates heart surgeon Samuel pollock, Jr.; Michael J. monthly to discuss short and long Imburgia, MD, FaCC; Mini K. Das, MD; (back row) William C. Dillon, MD, FaCC; John M. Mandrola, MD, term goals and general strategies FaCC; brennan M. Harraden, MD, FaCC; Jennifer a. Lash Crisp, MD, FaCC. on how to become more efficient.

The purpose, says Licandro, is to set direction. The Council formulates ideas, able to practice medicine as we saw fit and Physicians are concerned about the impact presents them as business plans to the hospital have input into the whole process. That is of health reform on their employment status board, and then implements the new strategy. where the Cardiology Council arose. We in part because they have been independent “Hospitals are like an air-craft carrier,” knew we needed a forum where both sides for so long. The details of the merger of observes Licandro. “It takes a lot of ocean to could meet and move forward on creative Louisville Cardiology Group with Baptist turn one of those. We are more nimble. We ideas. If we do not come to an agreement Medical Associates have two years of talks can change and adapt quicker, we can make about something then it does not get done. behind them and hundreds of hours of plandecisions faster. With this joint venture, we Everything is predicated on trust.” ning. If there is a lesson here it is to develop a are blending those cultures and finding out As it stands today, hospitals need to align clear direction on how you want to get where how to make it work. their physician networks so that patients can you’re going. “We spend a lot of time decid“We did a lot of soul searching and it be managed across the whole continuum of ing how we wanted our Cardiology Council took a lot of time for us to come to our care - Inpatient, outpatient, and post-acute. to run,” says Imburgia, “and we are going to decision. We decided that we could do this The goal is the enhancement of efficiency continue to develop our strategies together if we had certain safeguards in place. Those and effectiveness and improving outcomes over time. You can be employed and not give safeguards would ensure that we would be through cost management. up your autonomy.” ◆ 14 M.D. upDate

perspeCtives

What do You thinK? in the February 9 article in the new york y times, “Medical treatment, Out of reach”, author andrew pollack lays out the argument that the FDa has overcorrected from its previously too careless approval process that resulted in a sudden rise of device recalls.

Device manufacturers are turning to european markets first, and american patients must either travel abroad or wait for safer devices to gain FDa approval. it appears that the FDa will alter course again.

On February 8 it announced plans to speed regulatory review on certain innovative devices. some critics say the FDa is too lax and shouldn’t ease on any regulations. Others point out that the european and american recalls are similar. is the FDa right to yield to economic pressures and release some devices on an expedited schedule?

What do you think? email your response to: mcsmith@md-update.com

ICD replacement performed by rudolph Lincandro, MD, of Louisville Cardiology Group. photograph by Kirk Schlea (2011)

February 2011 15

pHysiCian vieWpOint

advanced Capabilities of the non-invasive vascular Laboratory By tHOMas H. sCHWarCz, MD The diagnosis and treatment of arterial and venous disease requires sophisticated imaging for accurate diagnosis and effective treatment. Due to continuing advances in imaging technology, CT angiography (CTa) and magnetic resonance angiography (MRA) have become increasingly utilized for evaluation of vascular disease. As a result, the cost of diagnostic vascular imaging has been rising at a disproportionately greater rate than would otherwise be expected. At the same time, advances in ultrasound imaging have significantly improved the capabilities of this diagnostic modality. The value and quality of imaging performed in the noninvasive vascular laboratory has been largely unrecognized and is often underutilized.

Duplex ultrasound consists of two components: B-mode imaging, which provides two-dimensional grayscale images, and color-flow Doppler with spectral analysis, which provides information regarding the direction and characteristics of blood flow in arteries and veins. Therefore, duplex ultrasound not only provides the static images of blood vessels, but also provides physiologic information regarding real time flow in blood vessels. Duplex ultrasound technology is able to provide significantly more information regarding blood vessels and blood flow than either CTa or MRA. Furthermore, the newest generation of ultrasound equipment has enhanced the acquisition of high quality images of arteries and veins throughout the body. Consequently, the capabilities of the noninvasive vascular laboratory have become much more advanced, and duplex ultrasound imaging has now arguably become the preferred primary noninvasive diagnostic testing modality for most vascular disease.

Carotid duplex ultrasound has been long established as the primary diagnostic test for extracranial cerebrovascular disease.

The accuracy of carotid duplex studies has been substantiated in many studies.

Furthermore, additional analysis of plaque characteristics from ultrasound images has 16 M.D. upDate

Lower extremity arterial occlusive disease can now be mapped in great detail using a duplex ultrasound. Several studies have demonstrated the accuracy of arterial duplex studies, thus eliminating the need for diagnostic angiography, and possibly CTa and MRA in many cases. Arterial duplex evaluation of the lower extremity also provides useful information to direct endovascular interventions. Specifically, this information can be used to choose whether balloon angioplasty, thomas H. Schwarcz, MD atherectomy, and/or stent placement would be the preferred approach also allowed for prediction of plaques that to the occlusive disease. Using this stratpose a higher risk for embolization with use egy, contrast angiography can be limited of carotid stents. For many years, a number to directing the appropriate intervention, of vascular surgeons have used duplex ultra- rather than for diagnostic purposes alone. sound as the sole imaging modality prior to Following endovascular treatment and/or carotid endarterectomy, completely elimi- lower extremity bypass operations, duplex nating the need for contrast angiography. ultrasound should be used to monitor the Evaluation of abdominal vascular dis- results of these procedures for restenosis, ease has more recently become routine which requires re-intervention to maintain with duplex ultrasound. The diagnosis and long-term patency. surveillance of abdominal aortic and iliac The diagnosis and treatment of venous artery aneurysms is now standard using disease has been revolutionized by applicaultrasound. Duplex studies are now also tion of high quality duplex ultrasonography. employed to monitor aortic stent-grafts The underlying cause for development of for endoleaks and residual sac dilatation varicose veins, valvular insufficiency and after abdominal aortic aneurysm repair. reflux in the venous system, can be clearly The accuracy of these duplex studies has identified by color-flow Doppler and specbeen demonstrated to be equivalent to tral analysis. Furthermore, duplex ultraresults from CT scanning. In addition, the sound is now used to direct endovenous use of duplex ultrasound for diagnosis of ablation procedures to treat diseased vein renovascular hypertension has superseded segments. These technological advances other diagnostic testing modalities (e.g. have largely eliminated the performance of nuclear imaging) due to its greater accuracy. vein stripping operations. For several years, Mesenteric arterial disease is now reliably duplex has been the principal test used to diagnosed with color-flow Doppler and diagnose lower extremity DVT. More spectral analysis. Duplex evaluation of the recently, duplex-directed catheter placement inferior vena cava and iliac veins is finding for the endovascular management of DVT an increasing prevalence of May-Thurner with thrombolytic therapy is a vital adjunct syndrome, left iliac venous compression for the new treatment of this dangerous associated with extremity edema and a clinical problem. potential predisposition for DVT. The The appropriate utilization of duplex presence of portal hypertension and mes- ultrasound has multiple advantages comenteric venous disease can also be identified pared to use of CTa and MRA. First, with abdominal duplex examinations. ultrasound testing is significantly less

Fig 1a: Normal carotid bifurcation

Fig 1b: extensive, calcified plaque in the carotid bifurcation

Fig 2a: Normal abdominal aorta

Fig 2b: Large abdominal aortic aneurysm

Fig 3: Normal left renal artery

expensive than either CT or MR imaging.

Second, duplex is safer for patients as there is no radiation exposure and potentially nephrotoxic contrast agents are not used.

Third, MRA cannot be safely performed in patients who have certain implanted medical devices (e.g. defibrillators, pacemakers, etc.). Finally, CTa and MRA imaging are limited by patient movement and arterial calcifications, which are quite common in vascular patients.

High quality, accurate vascular imaging can be obtained with duplex ultrasound, however, a few caveats regarding the use of noninvasive laboratory must be recognized.

First, ultrasound evaluations are much more “operator dependent” than other imaging modalities. The expertise of the technologist significantly affects the value of the study. Therefore, advanced ultrasound studies should be performed by certified technologists. The Registered Vascular Technologist (RVT) credential from the American Registry for Diagnostic Medical Sonographers (ARDMS) is the most widely recognized certification. Second, the most clinically useful results are obtained when examinations are interpreted by physicians with the Registered Physician in Vascular Interpretation (RPVI) credential. Third,

accreditation of a vascular laboratory by the Intersocietal Commission for Accreditation of Vascular Laboratories (ICAVL) is recognition of quality assurance. Accreditation may be achieved in several areas of vascular ultrasound testing, and the status of a laboratory can be found at www.icavl. org. Physicians ordering vascular ultrasound studies will obtain the most accurate and highest quality results from laboratories accredited in the specific area of testing, with examinations performed by a registered vascular technologist.

Duplex ultrasound may be effectively utilized as the diagnostic imaging modality of choice for almost all areas of vascular disease.

In addition, the use of duplex ultrasound is essential for the evaluation and optimal management of venous disease. As further scrutiny is focused on medical imaging expenses, duplex ultrasound testing by the noninvasive vascular laboratory will be increasingly recognized as the most cost-effective provider for evaluation of vascular disease. thomas H. Schwarcz, MD, rVt, rpVI, is a boardcertified vascular surgeon at the Vascular Lab at Lexington Surgeons and Vein Central. He may be reached at (859) 977-8346. ◆ February 2011 17

pHysiCian Q&a

president of the Lexington Medical society, Farhad Karim, MD M.D. Update publisher Gil Dunn talks with Farhad Karim, MD, who is a partner in Karim & Branch, PSC Asthma, Allergy & Immunology and who was recently installed as president of the Lexington Medical Society.

M.D. update: Many challenges face Kentucky physicians at the moment. at the top of the list are the shortage of primary care physicians, reduced Medicare reimbursement, and the swelling numbers of Medicaid-eligible. as president of the Lexington Medical society, what can you do to address these concerns?

Dr. Karim: At the Lexington Medical Society (LMS), our primary focus is to prepare physicians for the changes they will be facing as healthcare reform is implemented.

We do this by providing timely information as deadlines approach and providing physicians with resources to help them make decisions that will be in the best interest of their practices.

LMS is working closely with the KMA and AMA on advocacy issues. The AMA is the leading advocate for the permanent repeal of Medicare’s flawed sustainable growth rate (SGR), which is contributing to reduced access for Medicare patients and for military patients whose TRICARE coverage is based on Medicare rates. We are in contact with our state legislators to impress upon them how this payment crisis is affecting physicians and our patients.

It is estimated that by 2014, over 40,000 new Kentuckians will be eligible for health care under Medicaid. LMS has a committee chaired by Dr. Rice Leach that is drafting recommendations to manage the increased patient population. Initial thoughts are to consider a medical home model run by an organization with a CEO and that has a chief medical officer and seeks grants. We will consider incentives such as loan forgiveness for medical residents who provide care of this newly insured group.

New models need to be developed to 18 M.D. upDate

Farhad Karim, MD

coordinate the care of patients to the appropriate level of medical expertise. Going forward, patients will be able to access only the level of care and the type of practitioner such as physician, nurse practitioner, PA, or lay health worker, that is most appropriate for their health care need. tell us about the LMs community initiatives and the direction you envision for LMs outreach.

Lexington physicians have generously given back to the community in many ways over the years. Some of these efforts have not been as visible to the public as they could be. LMS will direct an effort to bring recognition to physicians’ good works, which will help repair some of the erosion of the patient–physician relationship.

One such effort is Lexington HEALS (Health, Economy And Life Sciences Institute). Under LMS leadership with the partnership of local hospitals and Commerce Lexington, HEALS brings awareness of the contribution of the medical profession to the community. Lexington is a healthy place to live, to learn about health sciences, and to obtain health services. The aim of Lexington HEALS is to promote that.

The Lexington Medical Society Foundation, founded in 1964, is another example of how physicians contribute quietly to the community. Our foundation gives nearly $40,000 per year to various community organizations and initiatives such as the Ronald McDonald House, Surgery On Sunday, Alzheimer’s Association, Camp Horsin’ Around, Nathaniel Mission Health Clinic and many more. We need to do a better job of promoting the Foundation to the medical community and try to increase participation in the Foundation to have even greater impact in the community.

How do area physicians benefit from membership in LMs? All physicians in our community benefit from the work of the LMS, but less than half of the physicians in our area are current members. We encourage all Fayette County physicians to join LMS because increased membership will strengthen our organization. I have been a member of LMS since 1983.

While it has been challenging due to the economic hardships we are all facing, we need to continue with our advocacy goals for the benefit all physicians and our patients. Some tangible benefits of membership are inclusion in the LMS membership directory - a valuable referral resource that both the physicians as well as patients have access to; a discounted rate for the medical society answering service; and the opportunity to attend general meetings, six per year, which are dinner programs with guest speakers, CME programs, and which are free for members. These programs also give the members an opportunity to network with other physicians whom they will not otherwise meet. Registration to attend the annual KMA meeting is free for all physi-

February 25 • 26 • 27 cians but only members can obtain free CME. Members receive a monthly newsletter and can participate in the annual golf tournament and picnic, which raises funds for the LMS Foundation. Members receive decals and certificates recognizing them as members in good standing. Mailing labels and list of all physicians are available only to members. Also, members have opportunities to participate in various committees of the LMS. please tell us about your special advocacy for physicians’ health.

I am passionate about promoting exercise, along with other lifestyle changes, as an integral part of maintaining good health.

I have and will continue to encourage all physicians to improve their own health with regular exercise and other lifestyle changes to become role models for their patients. I address physician’s health in the “President’s Message” of the February LMS newsletter.

I became a runner 30 years ago when I decided to stop smoking. Running helped distract me from the desire to smoke.

Since then, I have been running about six miles daily and have run numerous 5k and 10k races and 13 marathons, including the Boston Marathon. That’s the only marathon for which one has to qualify.

Therefore, it came as a shock to me and to everyone who knows me when I was diagnosed with coronary artery disease. This happened six weeks ago and required multiple vessels bypass surgery. Although this was disappointing, with my strong family history of heart disease, I am sure that exercise delayed the onset of the condition by 20 years. It also allowed me to develop excellent collateral circulation which possibly prevented a heart attack. Being in good health also helped me recover from surgery quickly.

Having successfully restored good blood supply to my heart with surgery, I expect to resume running again. This is yet another example of how one can partially overcome the expected unfavorable outcome of bad genes with regular exercise. I plan to share my story with everyone and continue to promote the benefits of regular exercise. ◆

The Art Museum AT T H E U N I V E R S I T Y O F K E N T U C K Y

Rose Street and Euclid Avenue, Lexington, KY, 40506-0241 859.257.5716 / www.uky.edu/ArtMuseum aib11ad_third page.indd 1

The Art Museum

1/18/2011 11:13:34 AM

The Art Museum AT T H E U N I V E R S I T Y O F K E N T U C K Y

The Art Museum

The Art Museum AT T H E U N I V E R S I T Y O F K E N T U C K Y

February 2011 19

Feature

at tHe heArt OF tHe Matter

The advanced cardiology practice today provides better coordinated care in a research-driven environment. This practice is typically quite large – a reflection of the complexity of the heart – and offers subspecialization in electrophysiology, invasive cardiology, and interventional cardiology.

20 M.D. upDate

LexingtOn Chest pain, shortness of breath, heart attacks, and heart failure. High blood pressure, irregularities of the heartbeat. That is the day-in, day-out practice at Lexington Cardiology Consultants, a nine-member group located at Central Baptist Hospital.

Beyond the ordinary, Lexington Cardiology Consultants (LCC) makes it a point to be an exemplary large-group cardiology practice. This high-volume, fullservice practice employs two diagnostic cardiologists, four interventionalists, two electrophysiologists, and one interventionalist / electrophysiologist.

Cardiology is a field of constant research anåd refinement. With each new generation of technology, physicians are able to provide more precise diagnoses and treatments. The practitioners at LCC embrace this drive to deliver the highest quality cardiac care available, each with an intellectual curiosity that compels individual research in his or her area of interest.

electrophysiology

A developing field of electrophysiology research is in the treatment of the stroke risk in patients who have atrial fibrillation.

Atrial fibrillation is an abnormal rhythm in the top part of the heart and the most common type of arrhythmia encountered in clinical practice. LCC electrophysiologist Dr. Gery Tomassoni says, “Treating stroke caused by atrial fibrillation is a costly problem for the US healthcare system. Within our area of expertise, we are trying to restore and maintain normal heart rhythms to reduce the risk of strokes that are associated with atrial fibrillation.”

Traditionally, atrial fibrillation is treated with the blood thinner warfarin; unfortunately, blood thinners can increase the risk of bleeding. Research has demonstrated that about 95 percent of stroke caused by atrial fibrillation results from blood clots emanating from the left atrial appendage. Tomassoni is investigating a new treatment device that can prevent blood clots from developing in the left atri-

Kevin t. Scully, MD, FaCC, Invasive Cardiology

Michael r. Jones, MD, FaCC, Interventional Cardiology

al appendage, known as the “Watchman” occlusive device. Forty-five days following the procedure the blood thinners are generally discontinued, the risk of bleeding being dramatically reduced.

Generally, the treatment strategy for atrial fibrillation is to restore normal sinus rhythm. Drugs, says Tomassoni, are only about half effective and carry a risk of pro-arrhythmia. Radio frequency catheter ablation, on the other hand, is effective for about 80 percent of patients who have been resistant to medical therapy. This treatment uses radio waves to burn the electrical conduits at the opening of the pulmonary veins of the top left atrium where almost all atrial fibrillations originate.

In order to manage the large volume of patients, LCC developed an atrial fibrillation center in cooperation with Central Baptist Hospital. There, a coordinator sets up all of the testing, advises patients on treatment options, follows patients’ medications, and when necessary refers the patient back to the clinic for to see a physician.

Diagnostic Cardiology

Dr. Kevin Scully, who with Dr. Michael Jones founded LCC in 1988, is an invasive February 2011 21

Feature

W. Gary boliek, MD, FaCC, Interventional Cardiology

cardiologist and specialist in clinical hypertension. His interests include hypertension, dyslipidemia, heart failure, echo, and nuclear medicine.

Scully typically sees patients with chest pains, shortness of breath, uncontrolled hypertension, or palpitations. He performs a history and a physical, performs and examination and perhaps a chest x-ray or an echocardiogram. “Most of the time, I have a very good idea of what’s going on based on the history and exam,” he says. Additional diagnostic studies that may be required include an echocardiogram, the wearing of a monitor to document arrhythmias, or a stress test. “If the patient is older and has multiple cardiovascular disease risk factors and changes on their EKG – these findings would be classic for symptoms of angina and would not controlled with medicine - I would suggest that the patient have a heart cath.”

Scully is involved in medical, acute coronary trials, a hypertension study, and two heart failure studies - LAPTOP and ECHO CRT. LAPTOP involves a special pacemaker 22 M.D. upDate

James K. Crager, MD, FaCC, Invasive Cardiology

that monitors the pressure in the left atrium and allows physicians to adjust medicines specifically for treatment of heart failure.

“Particularly, diuretics to reduce pressure within the heart. The study is seeking to determine whether this will be an effective therapy to keep patients more comfortable and keep them from having to come for repeated hospital visits,” says Scully.

The number of people needing treatment for heart failure, along with diabetes, seems to be increasing. As patients are living longer, they are at increased risk for developing hypertension and coronary disease.

The end result can be systolic heart muscle dysfunction, and with that come signs and symptoms of heart failure. “Systolic heart muscle dysfunction is difficult to control,” says Scully, “and we are hoping that this pacemaker will improve the quality of life and reduce mortality for these patients.”

Dr. Paula Hollingsworth, the only female cardiologist in the group, sees many young, pregnant women, and she says this is an important opportunity to help them change their lives since women are the predominant caregivers and deci-

azhar aslam, MD, FaCC, Interventional Cardiology

sion makers in most families.

Concerning the different presentation of heart disease among women, Hollingsworth explains that she performs the same diagnostic procedures on women as men. “Studies suggest that women do not get as many tests as men and that many symptoms are attributed to anxiety,” she says. “Women often do not receive care as aggressively as men.

For women’s atypical symptoms, I perform the same tests as I do with men. You often can’t rule cardiac disease out until diagnostic testing is performed.”

Hollingsworth reports that many women tell her that their greatest fear is that they have a problem with their heart.

Most of the time, Hollingsworth performs a stress test, which is about 85% predictive of whether a patient will have a heart related event in the next year.

“It is important to remember that stress tests are not perfect,” says Hollingsworth, “and you have to take people at their word regarding their symptoms. I always tell patients that if they do not feel better after we have done stress testing to make sure and come back. We may end up having to do a heart cath anyway.”

Hollingsworth has observed that in her practice coronary artery spasm seems to occur more often in women than in men. Symptoms of spasm can be elicited by methylergonovine, an agent that causes smooth muscle constriction. Smooth muscle constriction from any source is treated the same, from esophageal to coronary spasm. Patients are treated with calcium blockers and nitrates,” she explains.

“When you find people with classic anginal symptoms – those who require nitroglycerin every time they exert themselves – a methylergonovine challenge can sometimes reproduce their symptoms. They can then be treated with calcium blockers or nitrates and feel better.”

Interventional Cardiology

As an interventionalist, Hollingsworth’s primary interests are in structural heart disease, including valvular heart disease. Her

Michael rukavina, MD, FaCC, Interventional Cardiology and electrophysiology

paula Hollingsworth, MD, FaCC, Interventional Cardiology

Better coordinated care amid a culture of intellectual curiosity drives the advance treatment and prevention protocols in today’s large group cardiology practice.

February 2011 23

Feature

latest research involves the Amplatzer patent foramen ovale (PFO) occluder device.

The foramen ovale is a way for blood to shunt across the heart in an infant, bypassing the pulmonary circulation. For most people, this hole closes shortly after birth, but with about 25 percent of the adult population it remains open. There is some concern that this could lead to cryptogenic stroke.

Hollingsworth acknowledges that the exact cause of this stroke is unknown, but there is concern that a blood clot can form on the right side of the heart, cross through this little hole and go out into the aorta, causing the stroke. “With patients for whom we can identify no other reason for a stroke, we have felt that if we discover a PFO, it is reasonable to close this hole,” she says. “A study has just come out that suggests that the long-term outcome is similar whether the hole is closed or not. There is some disagreement with that and there are more trials ongoing.”

Dr. Michael Jones is involved in a unique, multidisciplinary stroke program at Central Baptist in which he contributes expertise with carotid artery stents. The program began ten years ago by comparing carotid stents to carotid endarterectomy in the treatment of arteriosclerosis.” In 2001, we published what remains the largest clinical trial study of carotid stenting versus endarterectomy in the Journal of the American College of Cardiology.”

The latest trial, CREST, was a multicenter trial in which half of the participants received the carotid stent while the other half had an endarterectomy. “The results showed that both treatments had about the same outcome,” says Jones, “but most patients prefer stenting because it is easier.”

Currently, the team is treating acute strokes with stents and other devices to open the arteries of the brain. Jones explains that the brain is the like the heart in that a blood clot in an artery to the brain is critical and requires emergency treatment. “We are now looking at a stroke as a ‘brain-attack’ in the same sense that a clot in the heart is a ‘heart-attack’. A patient coming to our stroke center goes right to the cath lab and 24 M.D. upDate

Gery F. tomassoni, MD, electrophysiology

get an angiogram. If a blood clot is found blocking an artery in the brain, we treat it very much like we would a blood clot in the heart. We use the same devices, the Merci retrieval device, the Penumbra, balloons and stents, for opening up acutely blocked arteries in the brain.”

Independent research

Many physicians at LCC engage in creative, independent research that seeks to resolve some of the discrepancies between a device engineer’s vision and the physician’s practice of medicine. “The device companies view their work from an engineering standpoint,” explains Tomassoni. “While we are performing the procedure, we discover ideas of what we need to do to make the procedure better.”

“Once we have an idea, we look for funding either though our own research program or through device companies. We then go through the regulatory process of writing a protocol and taking the idea to an institutional review board (IRB). They make sure we are not going to harm patients or put them at increased risk compared to other standard procedures. Finally we

aaron Hesselson, MD, FaCC, electrophysiology

launch the research program with coordinators involved to manage the informed consent process and the protocols following the procedure.”

Tomassoni has recently investigated the use of intracardiac echocardiography in the placement of the coronary sinus lead that allows the heart to pump more effectively in defibrillator patients diagnosed with left ventricular dysfunction and heart failure.

Jones is especially excited about the research into optical coherence tomography (OCT) and the potential it has in revealing thin-capped fibroatheromas (TCFAs).

TCFAs are the superficial liquid lipid pools in coronary arteries that, when they rupture, are the most likely cause of acute myocardial infarction. “There are about a dozen of these machines in North America, and we have one of them,” Jones boasts. “We are getting tons of information.”

OCT creates television-like image of the inside of the vessel. Similar to ultrasound, it reflects light of the vessel walls at a resolution 10 times greater than ultrasound. Jones says research projects are expected to begin in early 2011. ◆

SPECIALTIES

Pulse of surgery goes live LouisviLLe On January 12, 2011, about 60 Ramsey Middle School students attended the first “Pulse of Surgery” program at the Louisville Science Center. Students observed via broadbank link a live heart surgery performed by Dr. Mark Slaughter and the JHSMH surgical team. This was the first of a series of educational outreach programs geared toward engaging youth in possible future medical careers as well as inspiring them to take responsibility for their own health.

Donors to the Jewish Hospital & St. Mary’s Foundation have pledged $128,500 to the program and GLMS is providing an additional $100,000. The funding is for technology outfitting, development of curriculum and program materials, supplies, marketing, evaluation and Science Center staff. During the current school year, 10 surgeries will be broadcast live from Jewish Hospital, to students from Kentucky and southern Indiana at the Science Center.

“Pulse of Surgery” is planned to occur for several upcoming school years.

Open heart surgery performed by Hamid Mohommadzadeh, MD, with Surgical associates of Lexington.

Photograph by Kirk Schlea (2009) February 2011 25

OnCOLOGY

Madisonville Women Benefit from GY Oncology Expertise Once a month, women patients at the Merle E. Mahr Cancer Clinic at Trover Health System in Madisonville, Kentucky, get an opportunity to consult with highly trained specialists from the University of Louisville. Providing general OB/GYN and GY oncology treatment and surgery, among other conditions, is Dr. Lynn P. Parker, director of Division of Gynecologic Oncology and Thomas G. Day, Jr. Endowed Chair in Gynecologic Oncology at the University of Louisville.

When Parker joined UofL in 2004, she also took on the responsibility for the GY oncology clinic at Trover. She says she feels strongly connected to the program because she grew up in a small, southern Illinois town.

“I understand some of the problems people have with access to healthcare, particularly access to specialists. There are not many GY oncologists around, except a cluster of us in Louisville and a few in Lexington, Nashville, and St. Louis,” Parker

MADISONVILLE

patient needs and having a hard time lining up the resources to make it happen.

“We have social workers who will work overtime to help patients get what they need, whether that is access to chemotherapy drugs, decreasing the cost of healthcare for them, or transportation,” she says. “On the other end, there are charity funds that can sometimes help provide care for patients.

Lynn P. Parker, MD, Gy oncologist Some of our patients are in limbo, and they Strong bonds have formed, according stand to benefit the most from things like to Parker, between the clinic and the other this.” Parker says that the Trover clinic treats physicians in the community, as well as the everyone regardless of their ability to pay. “I nurses and other medical staff. “In a small like to practice that way,” she adds. town, everyone is willing to help,” she says.

Parker sees 15 to 20 patients per day in “That is one of the pleasures of this work the clinic, and from that patient population some will need surgery. Some of those surgeries have to be done in Louisville, but Parker says many are coordinated with Madisonville surgeons.

“We have actually maxed out what we can do with each clinic, so patients who are able and willing to travel come to Brown Cancer Center in Louisville. But for patients who are elderly, physically unable, or have transportation issues we always try to make things possible for them in for me. For example, my oncology nurse is Madisonville.” also a hospice nurse, so when some of my Parker offers both chemotherapy and patients see her in more than one phase surgical treatment for GY cancers. For of their care, they receive a lot of personal uterine and ovarian cancers, whose surattention.” geries used to involve very large incisions, Parker acknowledges a few downsides Parker now uses the robotic approach to rural specialty clinic care, such as trans- about 40 percent of the time. She notes portation. “Sometimes we need to perform that there are many promising new theraa procedure that cannot be done there, and pies on their way, including prophylactic it takes a lot of effort on everyone’s part surgeries where indicated. “That is a full to accomplish. If it were not for charity field of medicine that is really been growand social work efforts on both ends, we ing in the last few years,” says Parker. would not be able to get patients there and “These are some things with which we can back again. It’s frustrating to know what a really make a difference.” ◆

Strong bonds have formed, according to Parker, between the clinic and the other physicians in the community. explains. The GY oncology clinic allows Parker to facilitate care to patients in remote parts of Western Kentucky.

Parker finds that running a full-day clinic every other month creates a sizable opportunity to shape women’s’ health outcomes through the strong community connections they have formed there.

“Patients often talk to each other and spread the word about the services we have provided to them,” says Parker. “It has been good for getting the word out that there is a specialist available for ovarian cancer and cervical cancer.”

26 M.D. uPDate

REhABILITATIOn

Acquired Brain Injury Rehabilitation Frazier NeurOreHab

In February 2010, Jane Peters experienced a ruptured aneurysm in her brain. After surgery, she received inpatient treatment at Frazier Rehab Institute for two months and follow up outpatient care from Frazier Rehab Institute’s NeuroRehab Program, a comprehensive outpatient rehab facility that works specifically with individuals who have acquired brain injury.

Acquired brain injuries often occur during an auto accident, on an athletic field, result from a stroke or brain tumors, and can range from mild, such as a concussion, to severe. Frazier NeuroRehab (FNR) provides treatment to address all aspects of rehabilitation – physical, social/interpersonal, cognitive and emotional – with the ultimate goal of restoring each person to independence and productivity at home,

LOuISVILLE

Melissa Stover, Otr/L and Jane Peters at Frazier Neurorehab

Frazier NeuroRehab is a comprehensive outpatient rehab facility that works specif ically with individuals who have acquired brain injury.

work, school and in the community.

FNR offers a full-day program in addition to traditional outpatient rehab. Patients in the full-day program participate in both group and individual sessions with occupational therapists, physical therapists, speech therapists and psychologists. This program allows patients to bond with others facing similar challenges and to get to know their therapists more closely.

“The ability to be around individuals who are experiencing many of the same challenges can have a positive impact on a patient’s recovery,” says Melissa Stover, OTR/L, clinical supervisor with FNR. “Many of our patients have injuries and impairments that are not visible to those

around them. Spending time with others facing similar challenges during recovery can help validate what they are feeling and promote positive outcomes.”

Peters participated in the full-day program three days a week for two months.

“They acted like it was their goal in life to take me back to where I was before my aneurysm,” she says.

Emotional health is an important aspect to recovering from illness or injury. For that reason, FNR includes interaction with a clinical psychologist. This service provides the patients an opportunity to learn about their injury, the rehab process, and assist them and their family with acceptance and adjustment.

FNR employs an occupational therapist who specializes in return-to-work training. This therapist works closely with the patient and can educate the patient’s employer or provide on-site support services to ensure a smooth transition back to work. Also, an on-site case manager is assigned to each patient to assist the patient and their family with managing health/disability insurance, identifying other financial resources, management of medical questions, concerns and complication and advocating needs to physicians and other specialty providers.

Peters returned to work full-time in July.

Though she still experiences some balance issues, she has made a remarkable recovery.

She does physical therapy exercises at home and still has outpatient visits to the clinical psychologist at FNR. “We create a safe environment for our patients to practice the skills they need in order to return to their previous life roles,” says Stover. “We help them regain the skills needed for driving, independent living, managing finances, and academic and vocational pursuits. We often practice cooking and other home tasks in the clinic and make frequent trips into the community, such as visits to the grocery store or bank.” ◆ February 2011 27

AudIOLOGY

hearing Testing - There’s an App for That

28 M.D. uPDate

PraxiS biOScieNceS

I knew that if I practiced long enough, the need for some of my services would soon become extinct. The latest challenge to my practice comes from an iPhone app for hearing testing and enhancement called EarTrumpet. This app like others in its class seeks to deploy technology for greater access to medical care, and its potential looks promising.

Manufactured by Praxis BioSciences, LLC of Irvine, California, EarTrumpet is a hearing application suite. It contains a hearing test component that analyzes hearing without the use of special equipment or technical expertise, and it offers a hearing enhancer that amplifies and adjusts sound to improve audio quality via earphones.

EarTrumpet was developed by Allen Foulad, a a medical student collaborating with the Otolaryngology Head and Neck Surgery Department at the University of

KirK ScHLeaa

BY KAThRYn SAnduSKY, Aud

California, Irvine.

Early studies indicate significant accuracy of both the hearing test and hearing enhancement component. According to the Praxis BioSciences website (http://www. praxisbiosciences.com), efforts will remain

in place to refine and optimize the sound processing and hearing testing technology.

“These tools will pave the way for the addition of numerous innovative features to help promote the health of the ear and to diagnose and treat various ear conditions, such as tinnitus.”

While mobile apps are not a substitute for professional medical care, they may play an important role in health screening in developing nations and remote sites or as an inexpensive method for consumer self-screening for hearing loss.

So if you’re curious and would like to try the app, just download the EarTrumpet app on your iPhone. And of course, should you determine that you have hearing loss, do seek proper medical follow up. ◆

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2011 EDITORIAL CALENDAR JANUARY

Rural Medicin e

FEBRUARY

Cardiology

MARCH

Pain Man agement

APRIL

Or thopaedics & Spor ts Medicin e

MAY

Women’s Health

J UNE

Derm atology & Plastic Surger y

JULY

Intern al Medicin e & Prim ar y Care Inter

AUGUST

Pediatrics

SEPTEMBER

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Gil Dunn, Publisher (859) 309-0720 phone gdunn@md-update.com Megan Campbell Smith, Editor in Chief (859) 309-9939 phone mcsmith@md-update.com mcsmith@md-updat

February 2011 29

SPECIALTY FOCuS

new Paradigm in Vascular Care

Louisville Vascular Specialists at JHSMH offer the full spectrum of medical, surgical, and minimally invasive therapies for common blood vessel disorders.

30 M.D. uPDate

KirK ScHLea

LOuISVILLE Vascular specialists are not the practitioners you may think they are.

Management of vascular disease typically involves seeing patients for neck artery blockages, aneurysms, poor leg circulation, and varicose veins. Treatment for these conditions often conjures images of barbaric or painful procedures with complex names.

Dr. Stephen Self, vascular surgeon with Louisville Vascular Specialists, Jewish Physician Group, relates to the problem. “I do not think people understand that modern vascular surgeons are broadly trained to manage all aspects of vascular disease.

Many of the things we do now do not involve traditional surgery.”

Self says that today’s vascular specialists provide comprehensive care for arterial and venous disease. “For many patients, we may perform non-invasive testing to evaluate the extent of their disease and then manage them medically. We can help with risk factor modification, smoking cessation, and exercise programs. Some patients benefit from wound care and simple use of compression stockings.”

“Much of what we do is education for patients. We try to help them understand the disease process and what they can do to help themselves,” says Self. “We discuss cholesterol management, blood pressure control, weight loss, and family history which are all important factors.”

Atherosclerosis is the primary cause of vascular disease. Many patients with atherosclerosis also have heart disease. The advantage of having a vascular specialist is that they are familiar with all of the different ways that atherosclerosis can affect many areas of the body beside the heart.

The four physicians at Louisville Vascular Specialists (LVS), Drs. David Lipski, Suresh Alankar, Ferenc Nagy, and Self, each perform diagnosis and treatment of all vascular disorders at both Jewish Hospitals and Sts. Mary & Elizabeth Hospital. In addition to offering medical care, they can perform traditional open surgery which involves making incisions and bypassing, reconstructing, or cleaning our arteries. They can also perform minimally

David Lipski, MD

invasive procedures which involve using catheters through a needle stick to balloon, stent, or clean out arteries and veins.

By being familiar with every different approach to the problem, vascular specialists can customize the care that is most appropriate for each individual patient’s needs.

treatment Opportunities

Varicose vein treatment often entails stripping of the saphenous vein. “It sounds worse than it really is,” says Lipski. “It is a good operation that works well, but early on it is associated with a lot of pain and a recovery period that keeps people from going to work.”

The newer VNUS closure, a radiofre-

quency ablation procedure, accomplishes the same effect on an outpatient basis.

Under local anesthesia, VNUS closure is completed in minutes with minimal pain and a fast recovery. He advises that leg ulcers caused by venous disease can also be treated with minimally invasive techniques that do not require a full scale operation.

While the newer minimally invasive techniques have certain advantages, Lipski says that the open surgical approach should not be dismissed. Carotid artery blockages, which are associated with stokes and vision problems, are well managed with traditional surgery. The operation involves a small incision on the side of the neck so that blockage in the artery can be removed.

KirK ScHLea

“Carotid artery surgery has been around for 50 years, and it is very successful. It is one of the most scrutinized and studied operations ever developed. Pain and disability are minimal. Most of these operations only involve an overnight stay,” Lipski explains. “Even so, there are some individuals who may not do well with carotid surgery such as those with previous radiation or surgery to the neck or those in very poor medical condition. In those situations, a stent can be placed the carotid artery to open the blockage and prevent plaque from traveling to the brain which can cause a stroke.”

Self, who is very experienced with the treatment of aortic aneurysms, manages many patients with stent grafts. The traditional operation for aneurysms involves making an incision and replacing the enlarged portion of the aorta with a synthetic tube which acts as a replacement blood vessel. While the operation is completely curative, it may require a week long hospitalization and months to fully recover.

The endovascular or minimally invasive approach is done by placing the stent grafts through the arteries in the groin. The stent grafts act as a liner within the aneurysm which takes the pressure off of the abnor-

Stephen Self, MD

this same stent graft technology to people with thoracic and popliteal (knee) aneurysms.

Stent grafts have been a great benefit to many patients because it helps decrease the risk of potential complications that can occur from these complex operations. Many patients who are not candidates for open surgery can

Today’s vascular specialists provide comprehensive carefor arterial and venousdisease. mal portion of the blood vessel and keeps it from rupturing. The endovascular aneurysm repair can be done with local anesthesia and may only require an overnight stay.

Self says this approach “has been of great benefit to many patients, especially those that have other serious medical conditions that might make them high risk for surgery. In the past few years we have been able to apply

be successfully treated with one of these endovascular procedures.”

community awareness

As highlighted in a recent article in JAMA, vascular disease is often under recognized by primary care physicians. Louisville Vascular Specialists has been active in trying to promote screening programs for vascular dis-

ease. In addition, Self advises that there is a new Medicare benefit for abdominal aortic aneurysm screening. Patients with appropriate risk factors can receive aneurysm screening as part of their ‘Welcome to Medicare” physical. “Although the government approved this benefit, the word is not getting out to primary care physicians and patients,” says Self. “Like with any other disease that is a leading cause of death, we can reduce the number of deaths with screening and treatment rather than finding an aneurysm after someone has died from a rupture.”

Because vascular disorders are chronic medical conditions, having a designated provider who can offer advice and intervention as well as establish a pattern of regular follow-up will improve patient outcomes.

“The distinction that we try to get out to the community is that we are vascular specialists, not necessarily just vascular surgeons,” says Lipski. “As vascular specialists we can address patient’s problems over time and provide the most appropriate care by whatever method is indicated.” ◆ February 2011 31

March 26, 2011 Bluegrass Ballroom • Lexington Center

2011 Heart & Stroke Ball Chair James E.“Ted” Bassett III

Join us in honoring Ralph Hacker former “Voice of the Wildcats” & heart disease survivor.

Our evening will also feature a tribute to Sam Barnes.

of the Bluegrass

32 M.D. uPDate

For more information visit us at www.heart.org/lexingtonkyheartball or call the American Heart Association at 859-977-4605.

SEnd YOuR nEWS ITEMS TO M.d uPdATE > news@md-update.com

Jewish Hospital using da Vinci robot for cardiac Procedures KirK ScHLea

LOuISVILLE The comprehensive, minimally invasive heart surgery program at Jewish Hospital is now offering robotic procedures in a dedicated da Vinci OR. Dr. Sebastian Pagni, a surgeon with University Cardiothoracic Surgical Associates, recently performed the first da Vinci heart procedure at Jewish Hospital, a hybrid revascularization bypass. Pagni, at the console, was assisted by a specially trained OR staff including bedside assistance.

“With minimally invasive techniques, small incisions can be made between the ribs to perform coronary bypass or make repairs to the heart or esophagus by using thoracoscopy Sebastian Pagni, MD – the insertion of a miniaturized video camera between the ribs,” says Pagni.

“But this approach has limitations and is not often appropriate for more complex cardiac procedures,” he advises. “The da Vinci Surgical System is a more advanced cardiothoracic procedure that allows us to access the heart through small incisions in the right chest wall and avoid having to open the chest cavity.“ Dr. Mark Slaughter, professor Mark Slaughter, MD of Surgery and chief of the Division of Thoracic and Cardiovascular robotic features and how to best use the Surgery at the University of Louisville robot itself. and director of the Heart Transplant and Future robotic heart procedures, Mechanical Assist Device program at Jewish Slaughter asserts, “are limited by your Hospital, has planned an immersive experi- imagination. It is already being used to ence for Jewish Hospital heart surgeons take down mammary arteries and robotic receiving robot training. “We do not want assisted bypass. It is being used for people to dilute the initial experience for that who only need one or two bypasses. We are one person. We want the console surgeons ready to do mitral valve repairs. “ to become experts quickly,” he says. Staff Slaughter says that repairing atrial septal training includes visits to existing da Vinci defects is a possibility, and for misplaced heart programs, and several staff went to epicardial leads on biventricular pacemakIntuitive Surgical’s (who designs and builds ers, the robotic approach can relocate a the da Vinci system) Atlanta training center lead and return function to the pacemaker for hands-on experience. Intuitive Surgical’s while avoid a thoracotomy. There is also a proctors also provide on-site expertise on fair amount of use for pericardial disease,

nEWS

KirK ScHLea

pericardial cysts, and for people that need a biopsy. “There are a lot of potential uses that we are actively looking for.”

In quality assurance, Jewish Hospital will track patients throughout their hospital stay to demonstrate that the use of da Vinci results in less time in the ICU, shorter hospitals stays, earlier mobility, and less pain.

The da Vinci robot is just one component of the comprehensive, minimally invasive heart surgery program that Slaughter has brought to Jewish Hospital since he took the helm in 2008. Last year Jewish Hospital heart surgeons performed about fifteen aortic valve peripheral bypasses, a coronary bypass done through a very limited lateral wall chest incision. Slaughter says one of the goals of the program is to perform heart procedures through a nonsternotomy approach.

Generally, the minimally invasive approach results in a shorter ICU stay, shorter time on the ventilator, fewer transfusions, shorter hospital stay, and overall a quicker recovery. These along have cost benefits, and for working adults the savings can be significant when patients realize an earlier return to work.

Jewish Hospital is dispelling a common criticism of da Vinci cardiac programs - that a hospital cannot schedule enough heart procedures to pay for the machine – by diversifying its use. To integrate the da Vinci robot into the heart program, the machine first had to be moved out of the outpatient care center and into a dedicated OR where it is shared with urology and OB-GYN services.

Slaughter says that another difference lies in their careful promotion of services.

“There is a difference between promoting and advertising. We are promoting a minimally invasive program for individual cases. We don’t use the robot if it is not the best approach to take, and it is not the best approach for everybody.

“But for those patients that do meet indications and would clearly benefit, it is just not a valid criticism. I think that one of the biggest arguments for the use of the robot is that patients are happier because of their fast recovery experiences.” NEWS>>> February 2011 33

nEWS

as president and CEO of Our Lady of Peace. Nolan has over 20 years experience in behavioral health. She most recently served as a CEO within Universal Health Services, Inc., in Little Rock, Arkansas, where she managed child, adolescent and

program director for an outpatient wound care program at St. Joseph Healthcare in Lexington, Ky. He has held various leadership roles in both acute care and behavioral healthcare throughout his nursing career including Chief Nursing Officer for Psychiatric Solutions, Inc. in Houston, TX and The Ridge Behavioral Health System in Lexington, KY.

Silver Medal of Honor to Saint Joseph for Organ Donation

Lumy Sawaki, MD, PhD

aOta “certificate of appreciation” for Lexington Physician

Dr. Lumy Sawaki has earned the American Occupational Therapy Association (AOTA) “Certificate of Appreciation for Excellence, Passion, Inspiration and Unfailing Leadership.” This award recognizes extraordinary contributions to the advancement of occupational therapy.

Dr. Sawaki joined the University of Kentucky Department of Physical Medicine and Rehabilitation in April 2008 as the appointed Cardinal Hill Endowed Scholar in Stroke and Spinal Cord Rehabilitation.

Sawaki has developed a research program that focuses on stroke and spinal cord rehabilitation. She has received related grant awards from the American Heart Association, the Dana Foundation, the NIH, and most recently, the Christopher and Dana Reeve Foundation. She has a special interest in the development of novel rehabilitative strategies to enhance functional motor recovery after stroke, brain injury, and spinal cord injury.

LEXINGTON

Jennifer Nolan

adult general psychology, as well as adolescent and adult chemical dependency.

Christopher Schweighardt, RN, MSN, has also joined the organization as director of nursing services for child/ adolescent and adult general psychiatry.

Schweighardt most recently served as

New President/ceO and Director of Nursing at Our Lady of Peace

Jewish Hospital & St. Mary’s HealthCare has named Jennifer Nolan

LOuISVILLE

34 M.D. uPDate

christopher Schweighardt, rN, MSN

LEXINGTON Saint Joseph Hospital recently was awarded a Silver Medal of Honor from the US Department of Health and Human Services (HHS) for successfully increasing the number of organs available for transplantation. Saint Joseph Hospital is one of four Kentucky hospitals (one of 307 in the nation) to be recognized for achieving and sustaining national organ donation goals, including a donation rate of 75 percent or more of eligible donors.

Other Kentucky hospitals receiving this honor are Kosair Children’s Hospital, University of Louisville and Owensboro Medical Health System. Saint Joseph Hospital actually achieved a 100% conversion rate for the 18-month period under consideration (October 2008March 2010). Through carefully coordinated efforts and the generosity of families, six donors provided 12 organs to be transplanted to waiting recipients.

Saint Joseph Hospital’s partnership with Kentucky Organ Donor Affiliates (KODA) is paramount to its success in increasing life-saving donations. KODA provides staff members who specialize in working with donor families as well as provide important education to hospital personnel.

Saint Joseph Hospital also has an organ donation committee, led by clinicians, chaplains and KODA representatives, to maintain awareness of the organ donation program, increase the number of donations and honor the generosity of donor families.

nEWS

uPS Foundation Gives JHSMH Hazmat response Preparedness Grant

Jewish Hospital & St. Mary’s HealthCare is the recipient of a $16,500 grant from The UPS Foundation, the charitable arm of UPS. The grant will fund decontamination unit storage in the emergency department at Sts. Mary & Elizabeth Hospital, adjacent to the hospital’s planned decontamination suite that would be used in the event of a hazmat emergency such as chemical, biological or radiation exposure.

The decontamination suite and unit storage are part of dramatic improvements planned for the emergency department at the hospital, which is located in close proximity to Louisville’s most heavily industrialized areas.

Sts. Mary & Elizabeth Hospital is the

LOuISVILLE

only acute care hospital serving South Louisville, an area with a population of 176,000 people. More than 45,000 patients are seen annually in its emergency department – making it the second busiest in town.

About 70 percent of all patients admitted to Sts. Mary & Elizabeth Hospital come first through the Emergency Department, compared to a national average of about 45 percent. The Jewish Hospital & St. Mary’s Foundation has embarked on a $5 million campaign to fund a major renovation of the space, improving privacy and the ability of the staff to effectively deliver great patient care.

Medical Management Solutions Joins blue & co., LLc

The directors of Blue & Co., LLC are pleased to announce that Medical

CARMEL, IN

Management Solutions, a Central Kentucky based physician practice management business, has merged with the firm.

Medical Management Solutions (MMS) provides new practice development, existing practice management, billing and financial reporting, licensing and credentialing, and practice consulting. Their client base includes sole practitioners, group practices, partnerships, independent and hospital-owned primary care and multispecialty facilities.

As a result of the merger, Blue & Co. welcomes Lisa Coleman, owner of MMS, and her staff to the firm. Ms. Coleman graduated from Western Kentucky University in 1988 with a degree in Health Information Management and is a Certified Administrator in Physician Practice Management. After graduation she worked for St. Joseph Hospital in Lexington, Kentucky for five (5) years in

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nEWS

Lisa coleman

Utilization Review and Quality Management and as Manager in the Health Information Management Department. Since then, Ms. Coleman has held positions as Director of Physician Practice Management in the hospital setting and has held multiple Practice Administrator positions. She most recently held the position of CEO of Medical Management Solutions, Inc for the last 11 years.

Mrs. Coleman and the MMS staff will now operate as Blue Medical Management Solutions out of the Lexington office of Blue & Co. “The addition of Medical Management Solutions to the Blue healthcare practice offers yet another value-added service to our existing clients, “said Michael Stigler, director-in-charge, Kentucky market.

“Having worked with Medical Management Solutions in the past, we know that both firms share a commitment to quality service and personal attention often lacking in the healthcare industry. The introduction of Blue Medical Management Solutions to our existing services is a benefit not only for our respective firms but for our clients, as well.”

Frankfort regional earns aNcc Magnet Status

FRANKFORT Frankfort Regional Medical Center is now one of only five Kentucky hospitals to achieved Magnet status from the American Nurses Credentialing Center (ANCC).

“Becoming a Magnet hospital has been a vision of the nursing department for years.

Today we achieved that vision, which wasn’t only mine, but that of the hundreds of nurses who I work with everyday,” said Sammie Mosier, RN, BSN, MA, CMSRN, NE-BC, and chief nursing officer at Frankfort Regional 36 M.D. uPDate

Medical Center. “While it is recognition for nursing excellence, it is also recognition for a culture of quality, safety, and patient-centered care. This can only be accomplished when everyone works as a team, with a singular focus to be the best we can be.”

ANCC Magnet-designated hospitals provide patients and their families with a benchmark by which to measure the quality of care they can expect to receive. This status demonstrates the value that the hospital sees in nursing excellence, and it attracts the high quality nursing talent.

Recognition comes from a hospital’s adherence to the ANCC’s “14 Forces of Magnetism.” These standards encompass all aspects of hospital and nursing quality, including the following: the hospital’s role in the community; the level of engagement of nurses in hospital leadership activities;

the level of engagement of nurses in research activities and professional advancement; and the hospital’s quality of care and dedication to constant improvement.

energy Star for Norton brownsboro Hospital

LOuISVILLE Norton Brownsboro Hospital has received an energy performance rating of 97 in the US EPA 2010 Energy Star Awards program, placing it among the top 3 percent of hospitals in the United States for energy efficiency. It is the second Kentucky hospital to earn the Energy Star designation.

Energy Star is a joint program of the EPA and the US Department of Energy that saves money and protects the environment through energy efficient products and practices. The EPA provides an innovative energy performance rating system that

John r. Furcolow, MD, bill Harris, MD, and Dennis Havens, MD

three PMc Physicians best Doctors PIKEVILLE Pikeville Medical Center physicians Dr. Bill Harris, cardiology, Dr. Dennis Havens, cardiothorascic surgery, and Dr. John R. Furcolow, internal medicine, were added to the 2011-2012 Best Doctors in America list.

Dr. Havens and Dr. Furcolow, an internal medicine physician who just joined PMC this month, have earned the Best Doctors in America title every year since 2005. This year marks the second time Dr. Harris has earned the honor. He was featured on the list in 2008-2009.

The list represents the top 5 percent of doctors in the U.S. with more than 46,000 doctors practicing 400 specialties and subspecialties. The award recognizes doctors who earn the consensus support of their peers and meet additional qualifications. The physicians were nominated for the award by other doctors in America.

nEWS businesses already have used for more than 130,000 buildings nationwide. Top performing buildings are recognized with the prestigious Energy Star designation.

“Norton Brownsboro Hospital’s design incorporated as many energy efficient elements as possible, and obviously that has paid off,” said Douglas A. Winkelhake, president, Norton Brownsboro Hospital.

Because a strategic approach to energy management can produce twice the savings as typical approaches, EPA’s Energy Star partnership offers a proven energy management strategy that helps in measuring current energy performance, setting goals, tracking savings and rewarding improvements.

Norton Brownsboro Hospital, which opened Aug. 26, 2009, in northeastern Jefferson County, is Norton Healthcare’s fifth hospital and the first new hospital to be built in Louisville in more than 20 years.

CMTA, Inc., of Louisville, performed all mechanical, electrical and plumbing engineering for the hospital and submitted the information for the Energy Star award. Established in 1968, CMTA is a top 100 mechanical/electrical engineering firm specializing in sustainable design and technology.

New executive Director for Lexington Hearing and Speech center

LEXINGTON The Lexington Hearing and Speech Center has named Marcey Ansley as executive director. Previously, Ansley was the director of annual giving and public relations at Hospice of the Bluegrass.

Marcey ansley February 2011 37

nEWS

Lexington clinic awarded MGMa ‘better Performer’ Status; “best Place to Work”

LEXINGTON The Medical Group Management Association (MGMA) has identified the Lexington Clinic as a “Better Performer” in its Performance and Practices of Successful Medical Groups: 2010 Report Based on 2009 Data. This status recognizes strong performance in several areas, including cost management. Lexington Clinic chief financial officer Randy LeMay says, “We take our cost management responsibility very seriously, and this award shows that our efforts to control healthcare costs have been effective.”

The MGMA report, a benchmarking standard among medical groups for over a decade, was produced using data from respondents to the MGMA Cost Survey: 2010 Reports Based on 2009 Data as well as data from a questionnaire that assessed management behaviors, practices and procedures of better performers. The report profiles medical practices that have demonstrated success in one or more areas: profitability; cost management; productivity, capacity and staffing; accounts receivable and collections; patient satisfaction; and managed care operations.

Lexington Clinic has also earned the “Best Place to Work” Award from the Kentucky Chamber of Commerce.

Lexington Clinic was named one of the 39 best places to work in the large-sized employer category. The award is given in recognition of a company’s workplace policies, practices, demographics, and employee survey. This is the second year in a row that the Lexington Clinic was named a “Best Place to Work.”

breakthrough LGcP Procedure Performed by bluegrass Surgeons

LEXINGTON Bariatric surgeons Dr. G. Derek Weiss and Dr. John S. Oldham, Jr., of Bluegrass Bariatric Surgical Associates, performed the first laparoscopic greater curvature plication (LGCP) procedure in the 38 M.D. uPDate

is much smaller. It fills to capacity with a much smaller amount of food, so patients feel full quicker and therefore they eat less.”

Drs. Weiss and Oldham performed the 1-1/2 hour laparoscopic procedure on a 37-year-old woman with a history of morbid obesity, severe hypertension, diabetes, and sleep apnea.

Dr. Weiss says that preliminary results of the new minimally invasive procedure are similar to outcomes achieved with the sleeve gastrectomy, a procedure which involves laparoscopically removing the outer 85 percent of the stomach. The LGCP G. Derek Weiss, MD procedure currently involves an overnight stay in the hospital for most state of Kentucky January 17, 2011 at patients and is considerably less expensive Central Baptist Hospital (CB). LGCP is a than other currently available minimally new type of minimally invasive weight-loss invasive weight-loss surgical procedures. surgery which involves oversewing the outer Other advantages are safety, excellent part of the stomach so that it holds consid- first year weight loss, and the opportunity erably less food. to pursue other weight loss surgeries in the There is no cutting, removing or bypass- future should it be necessary. The procedure ing of the stomach in this reversible proce- is still experimental and data trails off at dure. It entails no foreign bodies such as in 1-1/2 years, but it is well suited for patients gastric banding. with an insurance exclusion. ◆ LGCP was pioneered by renowned surgeon Dr. Phillip R. Schauer, director of the Bariatric and Metabolic Institute at Cleveland Clinic. Dr. Schauer’s LGCP patients have experienced an average weight loss of 53 percent of excess body weight loss within the first year.

Dr. Weiss is the medical director of Bariatric Surgery at CB, which was one of 12 bariatric surgery practices throughout the US whose surgeons were trained to perform the LGCP procedure under Dr. Schauer.

“We can reduce the stomach volume by more 2/3 without removing any of the stomach because we’re not cutting or stapling,” explained Dr. Schauer in December 2010 after completing a pilot study of the LGCP procedure. “Patients lose weight with gastric plication because their stomach John S. Oldham, Jr., MD

itzhak Perlman at Singletary center for the arts

SATuRdAY MARCh 5, 7:30 PM LEXINGTON Itzhak Perlman will join the UK Symphony Orchestra, conducted by John Nardolillo, on Saturday, March 5 at 7:30pm at the Singletary Center for the Arts.

Itzhak Perlman enjoys superstar status rarely afforded a classical musician. In 2009, Mr. Perlman was honored to take part in the Inauguration of President Barack Obama. President Reagan granted him a “Medal of Liberty” in 1986, and President Clinton awarded him the “National Medal of Arts” in December 2000. In 2003, he was a Kennedy Center Honoree. In 2007, he performed at the State Dinner for Her Majesty The Queen and His Royal Highness The Duke of Edinburgh, hosted by President itzhak George W. Bush and Perlman Mrs. Bush at the White House.

Perlman devotes considerable time to education, both in his participation each summer in the Perlman Music Program and his teaching at the Juilliard School, where he holds the Dorothy Richard Starling Foundation Chair. He proudly possesses four Emmy Awards and fifteen Grammy awards. He was awarded an honorary doctorate and a centennial medal on the occasion of Julliard’s 100th commencement ceremony in 2005.

The program for the evening will include Mendelssohn’s Violin Concerto and Sibelius’ Symphony No. 2.

Tickets prices are $80/$70/$60 depending on seat location and are on sale now. Tickets can be purchased by calling the Singletary Center ticket office at (859) 257-4929, visiting online at www. singletarytickets.com, or in person at the venue.

ARTS

tango buenos aires at brown theater

WEdnESdAY MARCh 2, 7:30 PM LOuISVILLE Tango Buenos Aires will transform the Brown Theatre into a lush, sultry nightclub, where shadowy figures swirl and sway, intertwine and embrace to the seductive sounds of guitars. This elaborate, internationally-acclaimed production from Columbia Artists features a cast of twenty-five with live music, dazzling costumes and some of the hottest-blooded dancers in the world. Tango Buenos Aires will have your heart beating to the pounding rhythms of the dance of love.

Tango Buenos Aires performs at the Brown Theater Wednesday, March 2 at 7:30 pm.

Tickets prices are $38/$32/$28/$20 with discounts for Kentucky Center members. Tickets can be purchased by calling The Kentucky Center Box Office at (502) 584-7777 or visiting online at www.kentuckycenter.com.

February 2011 39

FeatureD PHySiciaNS

ARTS Michael Karpf have been enthusiastic supporters of the Art Museum, participatFloral interpretation ing as members and as

by Jennifer runnels part of the Collectors’ of Kreations by Karen group of supporters who help purchase art art in bloom at for the Museum. Ellen has served on the uK art Museum Museum’s advisory board and as the chairFRIdAY - SundAY, FEBRuARY 25 - 27 person for the Casablanca fund-raiser event.

The Art Museum at the University of Art in Bloom 2011 events begin Friday Kentucky is the site for Art in Bloom night at 7:00 pm with a Night of Elegance 2011. This is the eleventh year for this Black Tie Sponsor Gala and Live Auction. three-day event which showcases over fifty The celebration continues on Saturday, at floral arrangements created by professional 7:30 pm with a Night on the Town Cocktail and amateur designers from across the Reception and Silent Auction. Tickets for that Bluegrass who interpret works of art from event are available for $100 per person and a the Museum’s permanent collection and special $75 per person price for the under 40 the special exhibition Mid-Century Modern crowd.

The Museum “in full bloom” is open to from the Huntington Museum of Art. the public from 12-5 pm beginning Friday, This year’s event will honor Dr. Michael February 25 through Sunday February 27. and Ellen Karpf for their long-time supAdmission is $5 per person. More informaport of the Museum. Since their arrivtion is available at (859) 257-6218. ◆ al in Lexington in 2004, Dr. and Mrs.

Michael antimisiaris .......................... 6-7 Mini K. Das.................................... 12-14 William Dillon ............................... 12-14 John r. Furcolow ................................36 brennan M. Harraden .................... 12-14 bill Harris .................................... 6-7, 36 Dennis Havens ....................................36 Steven Hester .......................................8 Paula Hollingsworth ...................... 20-24 Michael imburgia ......................... 12-14 Michael r. Jones........................... 20-24 Farhad Karim ................................ 18-19 Jennifer a. Lash crisp ................... 12-14 rudolph Licandro .......................... 12-14 David Lipski................................... 30-31 rebecca McFarland ....................... 12-14 John M. Mandrola ......................... 12-14 John Oldham ......................................38 Sebastian Pagni ..................................33 Lynn Parker .........................................26 Lumy Sawaki .......................................34 thomas H. Schwarcz .................... 16-17 Kevin t. Scully ............................... 20-24 Stephen Self ................................. 30-31 Mark Slaughter ............................ 25, 33 Gery F. tomassoni ......................... 20-24 thomas M. tu ................................ 12-14 G. Derek Weiss ...................................38

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The New English Art Club : Contemporary British Figurative Painting March 2 - 19

Alex Fowler, NEAC (British, b. 1975) The Oleander, Oil on canvas 40” x 30”

Reception : Wednesday, March 2 6-8 p.m.

The New English Art Club was formed in London in 1885 by young British artists who had been exposed to, what was at that time, a novel method of painting : Impressionism. Their desire to break away from the formal and structured approach of the Royal Academy resulted in a rival show that was mounted in April 1886 with about fifty artists.

Its founders included the highly respected John Singer Sargent who felt that his fresh and innovative work needed “a venue that was perceived as being an outlet for ideas modern and French in the midst of the staid British art world”. (Uncanny Spectacle: The Public Career of the Young John Singer Sargent, p. 124).

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To learn more about our innovative and systematic approach to helping doctors and medical practices reach their financial goals, call Gregory Kasten at 859-296-4407 x 202 or visit unifiedtrust.com.

W e a lt h M a n ag e M e n t

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